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So Close, And Yet So Far

So this article on “food addiction” as an explanation for compulsive overeating would almost be good, if not for — as usual — the reporting. The lede informs us right off the bat that this is not an article about eating disorders, it’s an article about why people are fat — and the answer is, as always, it’s usually their fault.

Obesity has long been blamed on weak willpower, overeating, genetics and lack of exercise. Now scientists increasingly are seeing signs that suggest there may be an additional contributor: food addiction.

Ooh, there may be an additional contributor to that oh-so-comprehensive list! Who knew?

And that right there sets us up for what’s wrong with the whole article.

I’ve written about this before, but it seems to be coming up a lot lately, so let me recap my stance on this issue. Binge eating and compulsive overeating are forms of disordered eating. As such, they are rare. They are utterly devastating to the relatively few people who suffer from them, just as any eating disorder is, and they deserve the full attention of researchers who specialize in eating disorders. The current “treatments” available — dieting, 12-stepping, and trying to figure out “what’s eating you” — are woefully inadequate. People who eat this way need help, and they’re not getting it.

A big part of the reason they’re not getting it is that these disorders (which are increasingly being lumped together as “Binge Eating Disorder,” though compulsive eating and binge eating are somewhat different behaviors) are commonly seen as the usual eating habits of fat people. All fat people are fat because they eat too goddamned much, says the crowd, even though that’s patently false:

“Most obese people are no different from non-obese people,” [Dr. Albert] Stunkard says. They are not eating because they are depressed or because they have a pathological relationship to food or to their parents. If all you had was their scores on psychological tests — if you could not actually see the people you were testing — you would not be able to decide who was fat and who was not.

Maybe the obese eat differently, gulping their food or skipping breakfast only to binge later in the day? But no, that also turned out not to be true. Some overweight people eat quickly, some slowly. Some binge, some do not. Some eat when they are stressed; some lose their appetites in those circumstances. And, in every case, thin people are just as likely as the obese to exhibit those behaviors. There is no behavior that is typical of the obese.

But the mainstream media doesn’t seem to have heard of Albert J. Stunkard, or any of the other researchers who have come to the same conclusion. To reporters — to most of us — the idea that fat people generally eat just like thin people is unthinkable. Fat people eat too goddamned much!

And so the fact that a small percentage of fat people can’t stop eating too goddamned much, because they’re dealing with a serious mental health problem — which can lead to serious physical health problems — goes ignored. Those people, like all fatties, are merely weak-willed. They, like all fatties, just need to learn to push away from the table. They, like all fatties, are moral failures.

Worse still, people with these disorders internalize that message and fail to understand that their eating habits are not representative of the average (shameful, self-destructive) fat person’s, so they don’t seek out what help is available. Every time I post something saying that most fat people don’t overeat and fat people can be perfectly healthy, the most insistent objections come from people who eventually reveal that they do overeat compulsively and are unhealthy because of it. And they just don’t get that their experience is the exception, not the rule.

Why? Because the distinction is so rarely drawn. When the culture keeps telling us that fat people are fat because they shovel buckets of food down their throats at every opportunity, there’s no reason for people who do have an eating disorder to believe there’s anything wrong with them beyond what the culture tells them is wrong with them: they’re lazy gluttons with no willpower.

Personally, I buy into the “food addiction” concept where these disorders are concerned, but only as an imperfect metaphor. Addiction amounts to a nearly unshakeable belief that you need a particular substance, when you know intellectually that you don’t. But “food addicts” do need food. Overeaters Anonymous attempts to apply the abstinence-based 12-step model to food addiction by encouraging abstinence from “trigger foods.” (Sugar and white flour are two of the biggies.) To my mind, though, that’s swapping one form of disordered eating for another; it maintains the obsession with food that’s the hallmark of any eating disorder. It deprives people of the opportunity to learn how to listen to their own internal hunger cues, rather than fetishizing certain foods and rejecting any food that doesn’t fit into a predetermined eating plan. That makes me incredibly uneasy as a solution to disordered eating — although having said that, so little is known about these disorders that I can’t be sure a step like that is unnecessary in the first stages of breaking the cycle. I don’t really know what’s most helpful. Doctors don’t know. It’s fucking maddening.

But I can tell you what’s not helpful: articles about “food addiction” that seem far less concerned with discussing a largely overlooked eating disorder than with reminding fatties that IT IS STILL PROBABLY THEIR FAULT. The USA Today article ends with this:

Others pooh-pooh the idea of food addiction. “This is a dumbing down of the term ‘addiction,’ ” says Rick Berman, executive director of the Center for Consumer Freedom, a group financed by the restaurant and food industry. “The term is being overused. People are not holding up convenience stores to get their hands on Twinkies.

“Lots of people love cheesecake and would eat it whenever it’s offered, but I wouldn’t call that an addiction,” he says. “The issue here is the intensity of people’s cravings, and those are going to differ.”

Gee, thanks for the insight. Points to the author for noting who funds the Center for Consumer Freedom (which is why I never draw on them as a resource, even though they’re quite vocal about the obesity epidemic being overblown; I don’t like sources whose main goal is profit for large corporations, even if their reporting dovetails with what I’m trying to get across here), but why the hell does this clown get the last word?

Yeah, lots of people love cheesecake, but most of those people, even the fat ones, would not eat an entire cheesecake or two in one sitting. I love booze and take it damn near every time it’s offered, but I’m not an alcoholic (thank the fates). It is not a difference of “intensity.” It’s the difference between enjoying something in a healthy way (save the occasional hangover or tummyache) and making yourself chronically ill because you don’t know how to stop.

People who are immobilized by their fat and consumed by their eating behaviors are ill. And they are unusual. This article, like most, makes that distinction, but not to emphasize that people with Binge Eating Disorder need help and compassion — just to emphasize that other fatties aren’t off the hook.

Psychiatrist Nora Volkow, director of the National Institute on Drug Abuse, a speaker at the meeting, says the research in this area is complicated, but most people’s weight problems aren’t caused by food addiction.

And in case you missed that, or the opening paragraph, or the closing paragraph from a source the author fucking notes is questionable, she repeats Volkow’s position on this matter one more time:

She does not believe that most people are overweight because their brains’ dopamine systems don’t function properly.

Yeah, we get it. Most people don’t have this problem. Which is why this disorder needs more attention.

All right, credit where credit is due time: immediately after that, she at least acknowledges two factors that don’t rely on calories in/calories out. (“Genetic vulnerability and stress.”) And the quotes from researchers are lengthy, fair, and informative. And this one’s especially worth cheering:

“It’s surprising that our field has overlooked this concept for so long,” he says. “Society blames obesity only on the people who have it and has been close-minded to other explanations.”

Damn skippy.

Unfortunately, the slant of the article remains clear: we should be skeptical of people claiming “food addiction” exists, because it might make people who aren’t addicted to food think they have an excuse to keep being fat. So instead of shedding light on an issue that might help some people realize they have an eating disorder and are allowed to ask for help, the overall message is: you probably do not have a disorder, fatass.

Statistically speaking, that’s true. The vast majority of fat people aren’t food addicts. But when the ones who are can’t even recognize it, because all they ever hear is, “It’s your fault! Just stop eating so goddamned much!” a little more thought about how we frame these issues is in order. And if reporters truly believe that “Binge Eating Disorder is very real and devastating, and it’s been historically overlooked by eating disorder specialists” is a less important message to take from this study than “Most fat people have no such excuse for their fatness,” I don’t have much hope that that kind of thinking is gonna come any time soon.

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17 thoughts on “So Close, And Yet So Far”

This was a nice post.
Certain psychological specialists are trying to put obesity as an entry in the DSM-V (Due out in 2011!), for the same reason. Psychology has proven that:
A. Some obese people do suffer from having odd relationships wtih food, but at the most it’s a modest 20% (Give or take… that may be too high of a statistic [Remember what happened to the “HOLY SHIT OBESITY KILLS 400,000 per year!!! OMG!” thing :P.].
B. You, and Psychology both validate the notion that thin people can be involved with similar relationships with food.

They don’t have data that states that ALL (Or even beyond a reasonable doubt with more than half of all) obese people are like this, yet they want to go with the crowd again. I’m hoping I can attack them on this.

Weight bigots commonly used the “Half of America is addicted to shit food” attack point. When will people realize you can’t know a person’s lifestyle based on what they look like?

Good work, KH. Of course, there is a lot of disagreement out there as to what constitutes “compulsive overeating.” Some would say it’s any calorie intake above and beyond what it would take to get and keep a person thin. Or that it’s anything eaten by anyone who’s not naturally pencil thin for pleasure above and beyond basic nutrition.

It’s a funny thing, though. Tell those same people that if we have to give up our pleasure foods, they have to give up their alcohol, their coffee, their marijuana — none of which anyone critically needs for survival, and all of which carry a certain amount of health risk with usage — and they will scream bloody murder. The exception: 12-step types, many of whom, from my personal experience, seem to compete with each other for some kind of Most Abstemious award. Like God gives a fuck if you just ate a Ritz cracker.

This is one of those stories that makes me want to keep a food log. Just so I can wave it in someone’s face and say fuck you. I have to wonder, do any of these reporters and the editors who approve their stories KNOW any fat people? I mean, you’d think they would – they seem to be reporting that we are everywhere in growing number. How hard would it be to run this article concept by an actual fat person and then duck and cover?

Jon – there are people lobbying the APA for inclusion of obesity into the DSM, but the process of getting a new diagnosis into the DSM is arduous and slow…for a reason. It is better to be conservative with what is listed as a mental disorder. Binge eating disorder is already in there, by the way. I’m actually skeptical that obesity would be included because it relies on physical measures of the body, something I’ve never seen in any other description.

Still, I do imagine that a segment of the APA is very interested in having it included as then it is a subject for which they can bill.

You are right to say fatness and BED & CED are not the same, and yet you show more qualitative analysis and insight than any of the boffins, (as quoted). It makes me guffaw to read them expressing surprise that this addiction thing and looking at the brains of fat people never occurred to them, like a bunch of middle aged maiden aunts of yore happening upon a erect penis for the first time. As I keep saying, that will happen to you when you don’t condescend to practice medicine and science normally, that is starting from the people that actual are the subject of you inquiries rather than theories you thought were correct but turned out to be B/S.

I myself was a compulsive eater and as I am about 220lbs, their characterization of CE’s as at the far end of fat, is potentially as incorrect as their other expert but wrong theories on fat. I have heard of a woman size 8, saying that she resorted to posting her credit cards back to herself, in a desperate attempt to stop herself buying food.

As for food addiction, a lot of people are trying to sell this nowadays but it simply is too wrong to ever be right. As you say, the central definition is indistinguishable from normal eating, we all need food. You simply cannot shoe horn eating into concepts that are less complex than it.
I was not ever addicted to food, I simply felt an overwhelming need to keep consuming it, my appetite/ hunger was not functioning properly, it never shut off, and it was further stimulated, by all emotions whether happy or sad ones.
In fact any stimulus, including the mildest of physical activity seemed to set it off, it seemed to me to be an imbalance of the nervous system, possibly a neurosis and/or obsessive compulsive as opposed to an issue of the deliciousness/ addictiveness of junky foods.

I didn’t enjoy food at that time, in fact towards the end I came to hate eating and the boredom of it, you’d be surprised how the joy can go out of eating, when it has no rhythm or rhyme but is
just a constant pressing on your psyche.

As for the self-control, I’ve never used more, in terms of eating than I did then, its just that self-control was as relevant as rationality is to a screaming phobia.

Even if there is such a thing as food addiction, I don’t think there is a solution for it. After all, you have to have to food to live, period. It’s not going to kill you if you never have another cigarette or another drink or another snort of your illegal drug of choice. It will kill you if you never eat another bite of any kind of food. To my mind, there is no way to cure a substance addiction, stop a substance addiction, if you have to have that substance to survive.
I also don’t see liking food, enjoying food, eating food, as an addiction. It’s a fact of life that food nourishes us and allows us to live. How much we eat, when we eat, where we eat, what we eat, is what enriches our lives and is no one’s business. Our health, individually, is no one’s business, neither is our size.
This is not to say that eating disorders don’t exist, they do. But adding food addiction to the list of eating disorders muddies the waters and prevents people who do have eating disorders from getting the help they want and need (and keeps them from recognizing that they might have an eating disorder, because, OMG, it’s an addiction, so I’m a weak-willed, pathetic POS because I’m addicted and won’t do anything to stop being addicted). Personally, I’ve had my bouts with excessive drinking (for years when I was younger), and I quit with no problems, same with smoking (I smoked for 10 years and quit cold-turkey and never went back), but I don’t think everyone can do it and I don’t think less of people who struggle with ending an addiction, I realize how lucky I was to be able to quit as easily as I did. However, I have not been able to give up food, nor have I been able to be thin, ever, no matter what diet I tried, what drugs I took, or the WLS I did. Does that make me addicted to food? No, it makes me a human who needs food to survive, and fat for reasons other than food addiction. I wish these researchers could get it through their heads that people come in all sizes, shapes, colors, religions, sexes, ethnicities, whatever, and none of them are intrinsically better than any other one.

Brilliant once again, Kate. I spent years as a compulsive overeater. Then I gradually worked through my issues, learned to listen to my body, learned to distinguish physical hunger from any other eating cue I had accumulated over the years, learned to trust that I could keep previously triggering foods in the house without binging on them, got to the point where my diet is a hell of a lot healthier and far less guilt-ridden than it ever has been before, etc etc etc. And guess what? I’m still fat.

I bet you’re not surprised.

But now I’m fat and healthy (although I certainly have room to do a fair bit more exercise), and so far from hating my body, I get dressed in front of a full length mirror in my bathroom every morning and I like what I see. I’m still fat, but I don’t hate myself for being fat any more.

I would also like to see some recognition from health professionals/The Authorities/etc that some fat people do also have eating disorders of the anorectic and bulimic type. Seriously, if a slim girl or woman had been doing what I did, there’d have been concern all around and trips to the eating disorder clinic. Starving for a week, then bingeing and compulsively exercising for a week. Not eating anything or taking only tiny, tiny servings or having a glass of water instead of food – these all gained praise from those around me for being “so good”! I hid the bingeing, but I’d get further praise for exercising myself to exhaustion. It didn’t make me any thinner, that’s for sure.

If it’s an eating disorder in a slim person, it’s an eating disorder in a fat person. Except that the prevailing fat hatred and pursuit of “health” and “beauty” mark the fat person down for “get thin or die trying – and that’s ok!”. A HAES list I read once had a message from a frustrated eating disorder psychologist about one of her new clients, a 500lb woman who was, literally, dying of starvation in the same manner as severely underweight anorectics. All previous doctors and such had done was encourage her to “try harder” to lose weight. Because she must have been lying about not eating, right? How can someone possibly be fat and starving? Her problem must be compulsive lying, not anorexia! I went and cried after reading that one, tell me tell you.

I had exactly the same experience. Even when I realized I was slowly killing myself I was denied help because people thought I was making it up because I hadn’t suddenly become skeletal. In fact, the doctor I confided in actually gave me weight-loss advice instead. Yeah, that was helpful…

I finally found a therapist who acknowledged I had a disordered relationship with food, but because of my size she was convinced I was a compulsive over eater, even as I was panicking at the thought of eating more than 500 calories a day or spending less than 3 hours a day exercising.

But of course, I must have been lying. Because instead of shedding pounds left and right, I stayed almost the same weight and just got progressively weaker, sicker, and balder (I was losing hair from lack of nutrition). So instead of being taught to love myself enough to feel worthy of nourishment, I was taught that food is NOT my friend, and that I shouldn’t eat when I’m emotional. Ok…no problem. In fact, I have that pretty well covered.

I never did get REAL professional help, and I still have a sometimes messed up relationship with food, although I am much better. I was lucky enough to have a wonderful man in my life who has helped me believe I’m OK just as I am. The feminist in me hates saying that, but it’s true. My doctors may not have thought I was worthy of self-esteem, but he did, and that probably saved my life.

I guess my point in all this is that I believe it’s extremely important to remove weight from our ideas of what makes an eating disorder. Sure, disordered eating MAY have a noticeable effect on a girl’s weight, but it also may not. Just because her body doesn’t react the way you think it should or look the way you think it should does not make the damage she’s doing to her body any less severe. It does not mean she needs any less help. It’s an emotional and a behavioral disorder, please treat according to emotional and behavioral symptoms, not dress size.

I was lucky enough to have a wonderful man in my life who has helped me believe I’m OK just as I am. The feminist in me hates saying that, but it’s true.

For what it’s worth, I don’t think it’s antifeminist to admit the power of loving, respectful pair-bonding. A rational utilitarian emphasis on financial/social independence as a means of autonomy shouldn’t mean denying the importance of emotionally satisfying relationships.

The current societal infatuation with individualism can be a heavy weight to bear if one feels they have failed through not “making it on their own”. As a gregarious mammalian species, we are strongly adapted to seek emotional validation from group bonds and especially from partner bonds. For those of us who don’t fit the norm, finding group acceptance can be harder, so we need a thicker skin of self-reliance, but it shouldn’t be the be-all and end-all.

Finding satisfaction and support in group-bonds and pair-bonds should never be seen as unfeminist, IMO.

Still, I do imagine that a segment of the APA is very interested in having it included as then it is a subject for which they can bill.

I imagine there are some very powerful forces keen on redefining body size into a psychiatric illness because then they can very readily refuse and exclude huge swathes of the population from any form of useful insurance.

Tigtog, very well put. I was just going to tell Missa: dude, I hear you. (And even I had trouble owning up to the value of pair bonding there, which is indeed silly.)

Lauredhel, I think both are true. Fat Fu made some great points in comments here.

And that’s why, again, it’s so important to say that “some forms of EATING” are disordered, not “some forms of obesity” (as was proposed in the editorial I discussed above). If having an eating disorder is a “form of obesity,” then insurance companies could conceivably make premiums even higher for all fat people, not just those diagnosed with a psychiatric disorder.

I run or help run some on-line communities about size-acceptance and HAES, and I also co-moderate a community dedicated to non-dieting approach to compulsive eating.

I do think that many fat folks have problematic relationships with food because they’ve been pressured to diet for most of their lives, but I also have had a nagging suspicion that some of the fat women I talk to who think they are compulsively overeating probably are not particularly disordered but have been brainwashed to believe that they must be compulsively overeating or they’d auto-magically become thin. Some of the women in the group feel guilty for having a glass of wine or a handful of snack chips they don’t need because they ate for pleasure or for comfort instead of stopping when they got full.

You know, skinny people do that all the time but don’t think of themselves as compulsive overeaters. I don’t think it’s a crime to have a cookie because you crave one or to have an extra helping because you’re bummed out about something no matter what weight you’re at.

Anyway, you’ve said in this post many of the things I’ve been thinking but haven’t been able to articulate, so thanks.

Wow… this is so interesting. It never occurred to me that I didn’t have an eating disorder. Granted, I think I’m more on the compulsive eating end of the spectrum than not (my default mode for the past 15 years was to come home from school or work and eat mindlessly for a while, and I do have a tendency to eat way past full at times) but I must admit that I also grouped the extra helping or handful of chips that SarahR refers to into the compulsive eating category as well.

I’m not sure if I like this or not… on the one hand, it would be nice to think of myself as “normal” in a way that I haven’t ever since the day in kindergarten when this 4th-grade brat yelled out “look at the fatty stuffing her face with cake.” Of course anyone else could have brought their birthday cake to school without being subject to comment. On the other hand, it makes it that much harder to disentangle whatever “disordered” eating habits I do have from those that would be considered normal if I were thin. And it makes me feel in an odd way like I have no “excuse” to overeat (even though the urge is overwhelming at times) and the whole willpower thing rears its ugly head again.